New era of five-yearly doctor checks starts

Regular checks on doctors' skills will start from December, heralding the biggest shake-up in medical regulation for more than 150 years.

The UK's 220,000 doctors will have annual appraisals, with a decision taken every five years on whether they are fit to continue working.

But it will be April 2016 before the vast majority of the first round of checks have been done.

The health secretary said it was about addressing "deficiencies" in skills.

Jeremy Hunt said that if doctors failed to satisfy the standards of the General Medical Council (GMC) they would be prevented from practising.

But he said the new system was about identifying where there were "gaps" in knowledge or skills and giving doctors a "chance to put those issues right".

He said the vast majority of doctors "do a brilliant job" but when the government carried out a survey last year of 300 health bodies there were "serious concerns" with 0.7% of doctors - a figure Mr Hunt described as "significant".

"At the end of the day if the GMC is not satisfied that someone is up to speed then, yes, they will be prevented from practising," he told BBC Breakfast.

He said this would give the public confidence that the UK had the most thorough regulatory process for its doctors.

'Improve quality'

The move comes after years of discussions about the way doctors are monitored.

At the moment there are no mandatory checks on the performance of individual doctors, a situation which has been compared unfavourably to the airline industry where pilots face regular, on-going assessment.

Annual appraisals do happen in some places - particularly for medics in training - but they are by no means routine.

The new system

Revalidation by the General Medical Council will take place every five years.

It will run separately to the GMC's disciplinary regime that can lead to a doctor being struck off the medical register.

A decision on whether or not to allow a doctor to continue to practise will be based on annual appraisals and feedback from patients and colleagues.

It will be up to responsible officers in each organisation, normally medical directors, to make a recommendation to the GMC.

Minor issues may lead to revalidation being deferred for a short period while the problems are addressed.

Something that constitutes a risk to safety would lead to revalidation being rejected. The doctor would then not be allowed to work.

The revalidation process will start in December for senior medical leaders, including national and regional medical directors.

From April it will be rolled out among the general doctor population and within 12 months a fifth of doctors should have been through the process.

By April 2016 the "vast majority" of medics should have been checked.

There is, of course, a system of registration which the GMC is in charge of.

When serious complaints are made about performance, the GMC can start disciplinary procedures.

But this system essentially only picks up problems when things have gone wrong.

Revalidation has been designed to ensure issues are dealt with before they reach that stage.

GMC chief executive Niall Dickson said: "This is an historic moment. It is the biggest change in medical regulation for 150 years [since the creation of the GMC]."

He said the system should help improve quality, but he admitted the health industry had been "slow to recognise" the importance of such checks.

The introduction of regular checks - dubbed a medical MOT - has been talked about for more than 30 years.

Serious consideration started being given to the issue in the mid-1990s.

But over subsequent years scandals like that of the family GP and serial killer Harold Shipman and the deaths of the Bristol heart babies led to reviews and re-evaluations about what the process was intended to do.

Government and GMC officials have also had to have detailed discussions with the British Medical Association (BMA).

Dr Mark Porter, chair of the BMA's Council said it supported revalidation.

He added: "It is important to recognise, that while revalidation will undoubtedly enhance the rigorous testing that doctors undergo, clinicians are already offering patients a very high quality service and robust systems are currently in place to deal with any concerns.

"There is too much bureaucracy in the NHS and so we have to be careful that revalidation does not add to this unnecessarily."

Dean Royles, director of NHS Employers, said: "It is a very positive step forward and should herald greater patient safety and build confidence.

"Patients need and expect this. It has been a long time coming."

NHS medical director Professor Sir Bruce Keogh added it was a "powerful opportunity" to ensure standards of quality and professionalism are kept to across the country.

'4% concerns'

Each NHS organisation from hospitals to local networks of GP practices will have a responsible officer, such as a medical director, in charge of revalidation.

They will assess the annual appraisals along with feedback from patients and colleagues to make a recommendation about revalidation to the GMC every five years.

Minor issues that do not constitute a risk to safety may lead to revalidation being deferred for a short period, but major problems will result in the doctor not having their licence to practise revalidated.

Such a scenario could also lead to disciplinary procedures being started by the GMC, the ultimate sanction of which is being struck off the medical register.

During piloting and testing of the new system, concerns were raised over the performance of 4.1% of doctors.

In 2.4% of cases the issues were judged to be lower level, such as lateness, in 1% they were medium level, which included problems with behaviour including rudeness to patients, while in 0.7% the problems were serious and would have had an impact on safety.